An HIT Moment With … Jim Riley

An HIT Moment with ... is a quick interview with someone we find interesting. Jim Riley is president of Capario.

There are dozens of RCM vendors offering different services and serving different constituents. How would you categorize the major market segments and where does Capario fit in?

I would say the vendors in our market fall into one of three general groups.

The “back-end guys” are the legacy players whose primary value play is on the payer side. They have strong back-end payer connectivity, but their submitter offerings are lackluster. That’s because the bulk of their business and revenue is derived from the payers, which causes them to have a payer-centric view of the industry.

The “front-end guys” are the newer generation of clearinghouse/RCM vendors who came in with a submitter-focused strategy and new RCM solutions over the last 10 years or so. They built good front-end solutions, but rely on connectivity from other vendors. Transactions from this group are typically bouncing around to multiple different points to reach their final destination.

And then there are the “captive-audience players” who are primarily run by the demands of a parent organization. There are a number of vendors in the RCM space who are owned by a payer, a group of payers, a practice management or billing system, etc. Each of them has good offerings but their situation results in an owner-centric disposition of the industry. This group tends to be the least flexible of the three.

Capario really is a best of both worlds, blending of the first and second groups. We’ve been around for more than 20 years and have amassed thousands of direct connections with payers. This helps us to know how payers think and allows us to customize payer edits that we can push directly to the provider. That said, providers will always be our primary customers. It’s where we provide value in the revenue cycle. We’ve built our company’s focus around the needs of the provider community and have built one of the industry’s leading RCM portal applications.

CMS will begin accepting 5010 claims as of January 1, 2011 and the new format will be required by January 1, 2012. Is Capario, and more importantly providers, going to be ready for these deadlines?

Capario will be ready and we are actively testing with a handful of our customers and partners today. We think the vast majority of payers and large providers will be ready by 1/1/2012 as well. Some smaller submitters will struggle to meet the deadline but we have solutions to help them bridge the gap.

The bigger concern, frankly, is timing. Very few entities are ready today and we anticipate an incredible crush on resources and testing during the latter half of this year. It will be challenging, but these types of industry mandates are where Capario earns its stripes. Our plan calls for the ability to readily translate into and out of 5010 format as needed by our submitters and our payers. The industry needs entities like Capario to create flexibility around the implementation deadlines for all parties in order to ensure a smooth transition.

How will the transition to ICD-10 affect Capario and other claims clearinghouses over the next few years?

From a systems perspective, once we complete our 5010 system updates this year, we will be able to accommodate the ICD-10 codes. The bigger challenge will be with clients whose Practice Management Billing System cannot generate an ANSI 5010 file. 

Capario and many of our competitors are currently evaluating different solutions we can offer our clients that choose not to upgrade their system to the 5010-compliant version. Those options include both revisions to legacy file formats to accommodate ICD-10 codes and online portal solutions to allow customers to select the appropriate ICD-10 code for their claims. This is still a very fluid situation and we are actively pursuing all options to ease this transition for our customers.

If you could give a practice five criteria on which to choose an RCM vendor, what would they be?

Look for vendors that offer the most direct routes to the broadest list of payers. This is really important for two reason. You don’t want to make unnecessary stops. Just like with flights, every layover is an opportunity for a delay or problem. And,  you want a vendor who’s working directly with payers, that understands each payer’s edits and can push that information to the forefront. A vendor that can validate your files at submission will stop problems at the onset of the process, letting you fix errors and get claims back on their way quickly. No more costly and unnecessary delays.

Find a vendor that has visibility into the entire claims process, not just their portion of it. You need real-time tracking information for every step your claim takes on its way to adjudication and payment. Good, actionable information helps you fix problems fast. Beyond that, the vendor needs to offer business intelligence reporting tools that let you see the macro-level trends happening within your claims. When you have this kind of insight, you can make small billing changes that have dramatic effects on AR days and cash flow.

Find an option with a good and flexible patient eligibility verification system. You want a system that will let you do bulk file (think patient schedule-based) checks as well as ad-hoc individual and group checks. You want all of these options because bulk-file checks are the most effective, but you need the ability to run ad hoc inquiries as well.

Look for a vendor with staying power. Capario has been operating in this space for more than 20 years. There are a number of other long-term players in the industry, but there are also an equal number who have only been around for a few years. Experience really matters in this business.

Lastly, and on a very practical level, use the “contact us” test. Look for a vendor that makes it easy to talk to them. We get new customers everyday who are fed up with one of our competitors. Some won’t disclose support phone numbers. Some only offer e-mail support. Find a vendor who actively promotes how to get a hold of them and lets you talk to a live person. You’ll immediately increase your chances of having a good experience.

News 1/20/11

The 230-provider Summit Medical Group (NJ) picks athenahealth to provide RCM services. Summit will interface athenaCollector with its existing Allscripts EHR application. The Street apparently liked seeing athenahealth win business at the enterprise level: shares hit an all-time high Wednesday, reaching $49.30 and closing at $48.06.

Is this for real or perhaps a publicity stunt? Weno Healthcare issues a press release saying its ONC-ATCB application was denied without an appeal option. Apparently CEO Tina Goodman is unhappy with the situation and believes her company has the credentials to qualify as an ONC-ATB. Goodman says she has asked HHS Secretary Kathleen Sebelius to investigate “misconduct in the ONC’s ATCB application review process” because she believes ONC followed an unethical review process. She also suggests that Dr. David Blumenthal was involved in misconduct and believes her company’s application “threatened some who had political influence.” I can’t say whether or not Weno is qualified to serve as an ONC-ATCB, but it a quick tour of the Weno website indicates a business that’s not in the same league as Drummond/InfoGard/CCHIT and the rest. Weno’s primary service is a “free healthcare e community which connects healthcare organizations.” Just over a year ago, Weno announced it was offering a fully hosted, free EMR, but that product is no longer mentioned on Weno’s website. Something else interesting I found on Weno: the above press release from December 20th announces Weno’s approval as an ONC-ATCB; SpringCharts is lined up to be their first EHR tested.

Lenox Hill Radiology (NY) contracts with Healthcare Administrative partners to provide medical billing services.

EDI provider SSI Group partners with BNY Mellon to offer SSI provider clients a link to BNY’s electronic payment services.

The local paper claims that Norman, OK physician Cynthia Taylor is the nation’s first doctor to receive EHR stimulus funds. Whether or not Taylor was the very first, I’m sure she is pleased with her $21,250 check. Her office went live on eClinicalWorks in February of 2008.

Also from a local paper: Columbiana Clinic (AL) is moving its physicians to EMR. I’m guessing that’s pretty big news in a town that has a population of about 4,000. The four doctors are migrating one at a time and only two have made the switch so far. The first doctor reports her patient volume dropped from about 22-24 patients a day to as low as 10-12 per day, though it’s picking back up. The practice also plans to add a patient portal by January 2012.

PHRs have the potential to help patients manage their health, but technology needs to be designed with the patient in mind.That’s the opinion of two Virginia Commonwealth University family physicians whose editorial appears in JAMA. The physicians describe a new PHR model that goes beyond simply showing patients how to access health information. Key elements would include the collection and storage of information from patients and doctors, the translation of clinical information into lay language, informing patients how to improve their health based on personal information, and making actionable items for patients. In other words, leverage technology to make the PHR more relevant to individual patients. Great suggestions, but it still does not address the issue of who will actually enters the clinical data into the PHR.

The CEO for GW Medical Faculty Associates (MD) believes his practice’s advanced EHR (Allscripts) will help attract new physicians. The group is obviously pretty proud of its EHR usage which, according to the video on its Web site, is pretty extensive. The 550-physician GW Medical is negotiating to buy 15 different groups ranging in size from three doctors to over 100.

AHRQ will survey about 400 Medicaid providers over the next two years to identify barriers to the meaningful use of EHRs. AHRQ will tailor its technical assistance and support programs based on the feedback.

A pair of bariatric surgeons help create a free iPhone app that gives patients an idea of how they’d look with a few less pounds. Using the Thin Me app, patients can upload a photo and use the apps’ tool to reshape their figure. Patients can then forward the surgeons their before and after pics and ask for a price quote. The app was actually developed by Pixineers, a company specializing in medical apps to help doctors “increase patient interest and loyalty.”

E-mail Inga.

Intelligent Healthcare Information Integration 1/19/11

Home Runs & Hat Tricks vs. Game Winners & Buzzer Beaters

Jordan fades back, it’s up…it’s GOOD!!!

Who doesn’t love a good, last-second, game-winning, buzzer-beating score – in sports, literally, or at work, in a more figurative sense? We all want to be the one who nails an amazing game changer or at least be a part of the team that does.

On the EMR/EHR hunt these days, I’ve seen some pretty impressive home runs and even a few hat tricks. But, there’s a big difference between home runs and hat tricks compared with game winners and buzzer beaters.

In fact, many of the EMRs and EHRs I’ve looked at lately have hit a homer or two, maybe even completed a solid hat trick. But hat tricks and home runs are a far cry from game-winning grand slams. Many — maybe even most — vendors have found some really cool ways of getting certain tasks or job functions digitally handled. But, that is where the problem begins.

I’d wager that pretty much every EHR out there started off with at least one or two unique ideas, genuinely cool features or functions that hadn’t been created elsewhere. But since there is a lack of standardization, each of these cool tools must then have a full EHR built out around it. Unfortunately, the cleverness doesn’t seem to pervade the rest of the build out – almost never.

Thus, as the EHR hunt continues to show, really great ideas are often trapped within an overall dull total package. Slick data capture gets caught up with a horrendous user interface. Cool communication functionality gets mired in a mountain of clicks and drop-downs. Stylish user experiences get hamstrung by a lack of good templates or content. Fancy evidence-based tools lose value from dull-witted programming that causes unacceptably slow workflow.

Imagine if none of our electronic gadgets had a standardized plug or wall outlet design. All the best electronics in the world mean nothing if you can’t get power connected to enable their meaningful use.

Here’s a great example of a very cool tool I just learned about that would benefit from more intersystem connectability: Doctrelo eRx Plus. OK, this link doesn’t really give you deep insight into the product; it’s actually still in alpha. But, trust me: Doctrelo’s eRx Plus e-prescribing system, based on clinical problems and designed around how providers actually think, is the slickest e-prescribing tool I’ve ever seen.

Just like having a standard shape for electrical outlets and plugs, having such standardized EMR component “work-togetherness” would sure go a long way in bringing about real, cream-of-the-crop, game-winning EHRs. Goodness knows I’ve seen some really phenomenal parts and pieces recently. I continue to think, “What a great system I could create if I could take one from vendor A, two from vendor B, etc.!”

But then, as anyone who’s tried to charge their phone in Kathmandu or Kuala Lumpur will attest, we can’t even get electrical outlets or voltages standardized. I’m probably hoping for too much from my next EHR. Maybe just a good hat trick will have to hold me for now.

From the trenches…

“You have to expect things of yourself before you can do them.” – Michael Jordan

 

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from doc@madisonpediatric.com.

News 1/18/11

From Ann Thrax: “Re: Testimony for HIT Standards Committee. Have you listened to the testimony? You don’t want to miss hearing what Dr. Scott Monteith has to say.” The written transcript is not yet posted on the ONC site, but you can cue the recording around 2 hours and 49 minutes to listen to Dr. Monteith’s five-minute testimony. Here’s a snippet:

“ONC’s strategy has put the cart before the horse. HIT is not ready for widespread implementation. The problem isn’t Luddite doctors not adopting. The problem is that HIT isn’t ready, especially if we want safe and efficacious bells and whistles like CDS, interoperability, etc.”

From Doubter: “Re: Practice Fusion. Awesome interview, but it just doesn’t smell right. How do you have 500% growth and no idea when you will be cash flow positive, or better yet, turn a net profit?” In fairness, CEO Ryan Howard probably knows these details, but as a privately held company, he chose not to share.

Speaking of Practice Fusion, they were among the top six EHR vendors in a recent report by Black Box Rankings. The survey considered the satisfaction of primary care physicians with their EHR vendor. The other leaders included eClinicalWorks, DrFirst/Rcopia, Amazing Charts, Greenway, and ChartLogic. The Practice Fusion rep told me they earned more #1 rankings on individual criteria than all the other EHR vendors combined.

Hayes Management Consulting announces the formation of a new revenue cycle practice under the leadership of Sharon Christoforakis. She previously served as SVP of revenue operations at ABQ Health Partners and as a manager / consultant at Pricewaterhouse Coopers.

With the start of a new year, most deductibles are reset and patients pay more out-of-pocket costs. It’s also the time of year that the risk for embezzlement in practices is highest. Patients, unlike insurance companies, often pay in cash, and 45% of thefts occur before or after cash transactions are recorded on the books. The trend for higher deductibles and co-pays means the potential for embezzlement is rising. Consultants recommend that practices develop a system of checks and balances and provide plenty of physician oversight, including the monitoring of refunds and checking for “phantom” vendors. MGMA says that 83% of practice managers report that at some point in their career they worked in a medical offices where employee theft occurred. Less than 30% of practice embezzlers are prosecuted, though about 82% are fired from their jobs.

Please join me in welcoming MD-IT as HIStalk Practice’s newest Platinum sponsor. The Boulder, CO-based MD-IT offers medical transcription services and software that are used by over 7,000 physicians in 950 practices across the country. Their offering includes traditional dictation and transcription services, speech recognition tools, document management, EMR, health information exchange, and practice consulting, including assistance qualifying for Meaningful Use incentives. Their Web-based platform provides 24/7 access with 99.9% uptime and a nationwide network of regional offices providing local service options. MD-IT is also sponsoring HIStalk, so we are doubly appreciative of their support.

The 52-physician Infinity Primary Care (MI) joins the 1,300 member Henry Ford Physician Network. No doubt Henry Ford’s future plans include the formation of an ACO.

Patients looking for a primary care provider want to be able to access more detailed information online, according to a new Harris Interactive poll. Results also indicate that in the absence of quality data, patients will select their provider based on location and recommendations from family and friends. Also noteworthy: 42% of Americans are worried that healthcare reform will require them to change their doctors. These findings are based on a telephone survey of 2,020 adults, which has me thinking: am I the only person who avoids answering the phone if I suspect someone is calling about a survey or who refuses to participate if I answer the phone in error? I doubt it. So who, exactly, are these people that participate in phone surveys?

Think you are an EHR incentive program guru? Try taking this EMR Straight Talk quiz from the folks at SRSsoft. It includes all the details you should know if you are seeking Meaningful Use money. I actually found it a little tricky, yet my (perfect) score is listed above. Guess that means I get to keep my job for now.

As patients look for ways to trim their healthcare costs, more will likely turn to direct-to-consumer lab tests. In 2009, patients spent about $20 million on tests like lipid panels, hormone levels, vitamin D, and liver function. Look for the segment to grow 15 to 20% annually. The AAFP, of course, advises that patients seek counsel from their physician, since “there are a host of factors that go into whether a test is needed, warranted, or a waste of money.”

E-mail Inga.

Special Contribution from Darrell Ledbetter of Gastorf Family Clinic

Darrell Ledbetter, CPM, is practice manager for the two-physician Gastorf Family Clinic of Durant, OK. On January 4th, the clinic received a $42,500 EHR stimulus check for Meaningful Use of its EHR.

We are very elated to be among the first to be paid the EHR incentive. We worked closely with our Regional Extension Center (REC), the Oklahoma Foundation for Medical Quality (OFMQ), to prepare for the Meaningful Use of our EHR.

The REC initially came to us and said that they were here to help us meet Meaningful Use and that they were at our disposal. Our HIT practice specialist, Crystal Plata from OFMQ, brought information to our clinic that specifically plotted out what we needed to meet the Meaningful Use criteria. It spelled out the core objectives, measures and threshold numerators, and denominator exclusions required for us to obtain Meaningful Use.

We are partnered with e-MDs as our electronic health record. The e-MDs Solution Series version 7.0 was CMS certified on November 12, 2010. After attending the
e-MDs User Conference in July 2010 and attending the classes at the conference on Meaningful Use, it was fairly clear that we needed to work hard to begin ensuring our clinic could facilitate meeting those requirements.

The staff at e-MDs is very knowledgeable and the support center is wonderful. The final rule on Meaningful Use was, of course, not final at that point, but e-MDs had staff that was very involved with establishing those criteria.

We wanted to be on the front lines of the Meaningful Use, so as soon as we found out that the new version of e-MDs Solution Series was certified, we contacted e-MDs to ask if we could be a beta clinic for pushing out the new version. As always, the staff of e-MDs was very accommodating. We received the new version the last week of December and were able to meet Meaningful Use by January 1.

We were contacted by the Oklahoma Health Care Authority in mid-December and were asked if we would mind being the first clinic to get paid with the EHR incentive. Carter Kimble, public information specialist with the Oklahoma Health Care Authority, called and stated that our clinic’s name kept coming up as being on the cutting edge of meeting the Meaningful Use requirements through different agencies within the state.

So with that in mind, we really wanted to push forward and meet the requirements as quickly as possible. We wanted to assist the OHCA in getting the information out that there really was money out there for the program, and encourage other providers to participate.  We really feel that this is a worthwhile program, and pushing forward with the Health Information Exchange will be very beneficial to providers nationwide.

As soon as the CMS registration opened on Monday, January 3, 2011, we submitted our registration online. We then completed our patient volume documentation, showing that the patient care volume was greater than 30% Medicaid recipients. With that information, we knew that we would meet the criteria for participation in the Medicaid EHR Incentive program.

We then, with the assistance of the OHCA, completed our Registration and Attestation with the OHCA on Tuesday, January 4, 2011. Having documented and completed the requirements for upgrading to an EHR that had been certified to meet Meaningful Use, we were then presented with a check on Wednesday, January 5th. The actual funds will deposit directly through electronic funds transfer next early next week.

The initial investment in the EHR  software was five years ago, which was $26,652. Each year we have licensing fees of close to $7,000.00. This does not include the computer equipment, hardware, etc. We have 12 computers with the software on them, either laptops or desktop workstations. We have ordered a new server to upgrade our system, which will cost $6,500, and periodically have to replace other workstation computers or laptops, add memory, etc. 

So basically, this initial check will almost pay for the initial investment. If we continue to meet Meaningful Use, hopefully we will be eligible for the incentive payments for the next five years.